| NPI | 1811729601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024196638) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11037223) |
| 163W00000X Registered Nurse (Licence: FL RN9541003) | |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2026-04-13 |